Sunday, December 30, 2018

Small Minds and Big Mouths

Dr. Blowhard is in!
Image: Public Domain
According to an article in the Christian Post, Doctors speak out: Lupron and the 'diabolical' push to sterilize, gender-transition confused kids.

Apparently, one of those doctors used the word diabolical (it is in quotes in the headline) to describe a medical intervention which is consistent with the overwhelming scientific consensus for the treatment of severe pediatric gender dysphoria. One might also think, from the headline, that physicians who conform to the science are deliberately trying to sterilize gender dysphoric children. I have seen no evidence that puberty blockers cause sterilization and certainly no doctor intends for that to occur.

In other words, we don't have to go much further to know that the author of this post, Brandon Showalter, is dishonest. When someone can rely on verifiable facts there is no reason to be hyperbolic. The facts do not favor Mr. Showalter's position or that of the doctors he refers to. What is “diabolical” is using the Bible as a medical reference.

If anyone is “confused” it would be those doctors: Paul Hruz, Michael Laidlaw and Quentin Van Meter. These are Knights Templar who attempt to torture medical science into conformity with Christian scripture. None of the three have experience treating children with gender dysphoria.

According to these three:
…all of whom spoke recently with The Christian Post, Lupron — a hormonal agent that's employed to fight prostate cancer in men and is sometimes used to treat sex offenders — is now being injected into children who suffer from gender dysphoria.

The drug has never been green-lighted by the FDA for that purpose, nor has there been any peer-reviewed studies done on the drug's long-term physical and psychological side effects on children.
None of this has anything to do with the practice of medicine or a concern for children. Not an all. This is editorial content which is driven by religious disapproval of transgender people. They are, in fact, encouraging what amounts to malpractice.

What they are referring to is Lupron Depot which is used as a puberty blocker for children with extreme discomfort due to gender dysphoria. Referring to it as a “hormonal agent” is an attempt to obfuscate the fact that this drug is a hormone blocker.

The FDA permits doctors to make a professional determination meaning that off label prescriptions are perfectly legitimate. Research has determined the overall safety and dangers of the medication regardless of why it is prescribed. These three doctors — who know better — are essentially saying that medical professionals who specialize in this area and who do treat children with gender dysphoria are committing medical malpractice. Again, this has nothing to do with medicine. This is about scripture.

Later on in the post, Hruz concedes the point. Interestingly he is more concerned with legal liability than risks for the patient:
“It's not unusual, actually, in pediatrics to prescribe a drug off label. However, whenever a physician does that they are taking on significant risk because if something goes wrong without the evidence they are liable.”
Any physician who would preference religious belief — based on faith — over evidence-based medical science is a disgrace to the profession. What I find ironic is that those who receive puberty blockers, as well as their parents, are provided (by their doctors) with the information necessary to have a thorough understanding of benefits and possible complications.

On the other hand, the patients of these three doctors are unaware of the fact that they might not be the recipients of their physician's best medical advice. Rather, they might be receiving what the doctor considers to be the best advice and treatment, influenced by his religious beliefs. Who could possibly trust such a physician?

The diatribe continues:
Lupron and synthetic hormones are ravaging their developing bodies, altering their psyches, and putting them on a pathway to permanent sterilization, these doctors say. Many of the long-term repercussions will not be felt for years. At present, endocrinologists who refuse to back these experimental treatments struggle to be published, and many in the medical field remain unaware of what is going on in dozens of transgender clinics at children's hospitals across the nation.
How did “synthetic hormones” get into this? I thought that this was about puberty blockers. “Altering their psyches?” Where did that come from? A sermon? Every drug that we take has potential side effects. Every prescription for every human condition is premised upon the professional judgment of a doctor that the benefits far outweigh the risks. These three give no weight to the benefit side of the equation because of their religious disapproval.

As for getting published, science is philosophically agnostic. Yet, they are claiming that endocrinologists are being censored by the medical journals. Nonsense! To survive peer review and get published requires only the basic elements of scientific investigation. Is the methodology sound? Is the evidence reliable? Do the investigator's conclusions reasonably correlate to the evidence? Scripture is not evidence. If they really cannot get published it is likely because peer review usually weeds out crackpottery.

Paul Hruz is a board certified pediatrician in Missouri with a subspecialty in pediatric endocrinology. His views are at odds with the Endocrine Society with respect the treatment of children with gender dysphoria. Hruz' practice is focused on pediatric diabetes. He has never treated children with gender dysphoria. According to court records:
Dr. Hruz is an Associate Professor of Pediatrics in the Division of Pediatric Endocrinology and Diabetes at Washington University School of Medicine in St. Louis. He is proffered as an expert witness based on his study of “existing literature related to the incidence, potential etiology and treatment of gender dysphoria.” … Translated, it appears to mean that he has read some things about it. Dr. Hruz admits that he has not treated any transgender patients, patients with gender dysphoria, conducted peer-reviewed research about gender identity, transgender people, or gender dysphoria; and is not a psychiatrist, a psychologist, nor mental health care provider of any kind, who could speak knowledgeably about the effects of Defendant’s discriminatory policy on transgender students, let alone Plaintiff.
Hruz signed a letter from the American College of Pediatricians (a small hate group not to be confused with the American Academy of Pediatrics) to the Trump administration. The letter praised Trump's anti-LGBT measures and voiced support for a policy that would redefine sex to eliminate gender from consideration.

Michael K. Laidlaw practices endocrinology in California. Laidlaw is not board certified in any specialty. Above all else, Laidlaw is a professional Catholic who is obsessed with transgender people. He has written anti-trans tirades for a number of conservative Catholic outlets. Laidlaw also signed the American College of Pediatricians letter to the Trump administration.

Quentin Van Meter; Peachtree City, GA; is a board certified pediatrician with a subspecialty in pediatric endocrinology. Van Meter recently settled a malpractice suit for $1 million. Only one in five malpractice suits ever leads to any form of payout. Van Meter's practice is focused on pediatric diabetes. He does not treat people with gender dysphoria. Van Meter is president of the American College of Pediatricians.
Psychiatrists are the primary care providers for children with gender dysphoria.
Psychiatrists, in consultation with the child and his or her parents, determine if puberty blockers are necessary for the proper treatment of the child. As medical professionals they discuss the benefits and risks of puberty blockers. Psychiatrists refer those patients to endocrinologists who further evaluate the child. Once again, parents and the patient are counseled about the benefits and risks of puberty blockers.

In other words, the judgment of two medical professionals is necessary for a kid to get Lupron Depot. With puberty blockers, a child is given the luxury of time to clearly determine their gender identity. Without puberty blockers, we end up with trans boys who have female breasts and trans girls with beards and other male characteristics. This only adds to their distress. The general consensus is that puberty blockers are fully reversible.

Hruz, Van Meter and Laidlaw are not responsible for determining if a child should receive puberty blockers. They are not qualified to do so as is clear from the cited court record regarding Dr. Hruz. These three object to puberty blockers because they can ease a gender transition, something they oppose. They do not approve of transgender people because of religious dogma.

Pro forma BS from Hruz:
Overwhelming evidence exists that the vast majority of affected children will spontaneously realign their gender identity with biological sex when left alone, Hruz said of the relevant medical literature on the subject. And if they do realign they're not going to be tethered to the medical establishment for the rest of their lives because their bodies are not dependent on the chemicals.
Hruz is correct but at the same time misleading. Most kids do grow out of gender dysphoria. However, when the severity of a child's torment warrants puberty blockers, the condition is highly unlikely to just go away. Kristina Olson at University of Washington and head of the highly regarded TransYouth project has published research on this matter. In simplest terms, children who transition are unlikely to desist later on.

Christian conservatives claim that the transition creates the commitment to “transgenderism.” The more logical hypothesis is that the difference between kids who transition and those who do not is the severity of the condition. It then logically follows that the more severe the condition is, the more likely it is to be persistent.

Dr. Olson has also pointed out that transitioning relieves much of the anxiety and depression that gender dysphoria creates. This reduces the potential for self-harm. The American Academy of Pediatrics independently reached the same conclusion.

I am not a doctor but I know religious bullshit when I see it. It is not necessary to be a doctor to separate the dogmatic nonsense from medical science. In this case it is actually quite simple:
These three doctors provide no alternative.
Religious crackpots never — ever — cite a study or provide evidence that any medical intervention can cure, or even diminish, gender dysphoria. The reason that they cannot do so is because it does not exist.

These three doctors are not acting as medical professionals. They should form a prayer group and relegate their religious drivel to that venue.

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